title: The posterolateral mid-forearm perforator flap: anatomical study and clinical application.
abstract: BACKGROUND
  Defects sustained at the distal forearm are common and pedicled perforator flaps have unique advantages in resurfacing it. The purpose of this study is to reappraise the anatomy of the perforator in the posterolateral aspect of the mid-forearm and present our clinical experience on using perforator flaps based on it for reconstruction of defects in the distal forearm.
  
  
  METHODS
  This study was divided into anatomical study and clinical application. In the anatomical study, 30 preserved upper limbs were used. Clinically, 11 patients with defects at the forearm underwent reconstruction with the posterolateral mid-forearm perforator flaps. The defects, ranging from 4.5 × 2.5 cm to 10.5 × 4.5 cm, were located at the dorsal aspect of the distal forearm in 6 cases and at the volar aspect of the distal forearm in 5 cases.
  
  
  RESULTS
  Three patterns of the perforator were observed in the posterolateral aspect of the mid-forearm, which originated from the posterior interosseous artery, the proximal segment of the radial artery or the radial recurrent artery, and the middle segment of the radial artery, respectively. The perforator was located 11.8 ± 0.2 cm to 15.8 ± 0.4 cm inferior to the lateral humeral epicondyle. Clinically, flaps in 8 cases survived uneventfully, while the other 3 cases suffered mild marginal epidermal necrosis, which was cured with continuous dress changing.
  
  
  CONCLUSIONS
  The location of the perforator at the posterolateral aspect of the mid-forearm is consistent; the posterolateral mid-forearm perforator flap is particularly suitable to cover defects in the distal one-third of the forearm.
authors.affiliation: Anatomic Department, Fujian Medical University, Fuzhou, 350108, Fujian, China.
authors.forename: Yue-Hong
authors.initials: YH
authors.lastname: Zhuang
authors.affiliation: Department of Hand Surgery and Microsurgery, BoAi Hospital, Taizhou, Zhejiang Province, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Lin
authors.affiliation: Department of Endocrinology, Anxi County Hospital, Quanzhou, Fujian Province, China.
authors.forename: Fei-Huan
authors.initials: FH
authors.lastname: Fu
authors.affiliation: Jinnan Division, Jinjiang Municipal Hospital, Quanzhou, Fujian Province, China.
authors.forename: Zhen-De
authors.initials: ZD
authors.lastname: Cai
authors.affiliation: Jinnan Division, Jinjiang Municipal Hospital, Quanzhou, Fujian Province, China.
authors.forename: Hui-Mei
authors.initials: HM
authors.lastname: Huang
authors.affiliation: Department of Comparative Medicine, Anatomical Institution, General Hospital of People's Liberation Army Nanjing District, Fuzhou, 350108, China.
authors.forename: He-Ping
authors.initials: HP
authors.lastname: Zheng
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005542:Forearm / Q000098:blood supply* / Q000601:surgery; D005543:Forearm Injuries / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D061525:Perforator Flap / Q000098:blood supply*; D017534:Radial Artery / Q000033:anatomy & histology / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*; D017695:Soft Tissue Injuries / Q000601:surgery*; D016896:Treatment Outcome